A 70-year-old woman with bilateral lower limb claudication undergoes CT angiography showing severe stenosis of the right common iliac artery. She is referred for percutaneous transluminal angioplasty (PTA) with possible stenting. Which fluoroscopic landmark is used to access the femoral artery safely below the inguinal ligament?

• A Medial third of the inguinal ligament, at the level of the pubic symphysis
• B Lateral to the femoral nerve at the level of the anterior superior iliac spine
• C At the level of the femoral bifurcation, below the lesser trochanter
• D At the midinguinal point, over the femoral head, below the inguinal ligament ✓

Explanation

Safe femoral arterial access for angiography and intervention requires puncture of the common femoral artery at the level of the femoral head (midpoint of the inguinal ligament, midway between the anterior superior iliac spine and the pubic tubercle). The femoral head provides a bony surface against which manual compression can achieve hemostasis after catheter removal. Puncture above the inguinal ligament risks retroperitoneal hemorrhage, which is uncompressible. Puncture below the femoral bifurcation risks pseudoaneurysm formation at the smaller diameter superficial or profunda vessels.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.